Failure to Provide Required Consecutive RN Coverage
Penalty
Summary
The facility failed to provide eight consecutive hours of registered nurse (RN) coverage per day, as required, which had the potential to affect all 68 residents. Payroll-Based Journal records for the second quarter of 2025, along with staffing schedules from January through July 2025, showed multiple dates where there was no RN coverage for the required consecutive hours. The facility assessment tool indicated an average daily census of 69 to 78 residents, and the staffing plan was based on resident needs, but the facility did not meet the RN coverage requirement on numerous specific dates. Interviews with the Director of Nursing (DON) and Assistant Director of Nursing (ADON) confirmed the lack of RN coverage on these dates and verified ongoing shortages, particularly on weekends. The DON stated that the facility had only one RN on nights, two PRN RNs, and a wound nurse who was on medical leave. The facility was unable to accept residents with central lines, TPN, or orders for IV therapy more than twice a day due to the lack of available RNs or IV-trained LPNs. The DON and Administrator confirmed that there was no staffing policy in place and that staffing decisions were based on the facility's budget. Efforts to recruit RNs included job postings and participation in job fairs, but these had not resulted in sufficient hires to meet the required RN coverage.